Claim total
$903.69
base $93.83 · payer covered $903.69
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 2008-02-22
- Stop
- 2008-02-22
The parties
- Patient
- patient Nena Josephine Stehr
- Provider
- provider Eduardo Rubio
- Care site
- care site OPTAGE PRIMARY CARE LLC
- Payer
- payer Dual Eligible
Record id
00eec58c-8547-4a29-03b2-fd439317ff37